1. Reread the stern words, hammered into a sterile printout. The scope results: a scythe. Images of an alien inhabiting his inner world.
2. Notice the footprints on our living-room floor. Briefly consider cleaning.
3. Three breaths later. Hug him. Hug the kids. Hug myself. Hug the dogs. Tilt my head when he says that he doesn’t want to hug right now.
Dear Dr. Anonymous:
Are you a Phil, Michelle or Darrell? Two years ago, you booted my seventeen-year-old son out of treatment, signing your denial letter “MD Psychiatrist.”
I understand that you were hired to qualify, or disqualify, patients based on a cost-benefit analysis. Your letter suggested that my son’s condition could be “managed at a lower level of care.”
The first thing I notice are the dark circles under Mr. Jones’s eyes.
It’s 4:30 pm on a Wednesday during my third year of medical school. I’m in the fifth week of my family-medicine rotation, and we’re deep into our daily routine: triage, history, physical examination, differential diagnosis, present the case to the attending physician, repeat.
David Edelbaum ~
When I finished my medical training, almost sixty years ago, I was like many new graduates: I thought I knew it all.
I opened a private office in Los Angeles and paid courtesy calls on the local physicians to let them know my qualifications and my availability for consultation, as both an internist and a nephrologist. (The treatment of kidney disease was then in its infancy, and I was the area’s first such specialist.)
With a wife, two children under age four, a home mortgage and an office to support, I needed to make a living. I took call at the local emergency rooms, worked nights at the VA Hospital and told my answering service to mention my availability
My Nicaraguan pediatrician friend astutely summarized her work: First you make the clinical assessment, then you make the financial assessment. In other words, a clinician may know the right treatment, but what good does that do the patient if the treatment is entirely out of reach financially?
When I retired from teaching in a suburban school district north of Detroit in June 2003, I left Michigan for my hometown of Pittsburgh with boxes of belongings, twenty-nine years of memories, and health insurance tied to my state pension. That insurance has served me well–except when it has not.
Amrita Seehra
About the artist:
“Krithika Kavanoor (left) and I are both family-medicine residents at Montefiore Medical Center in the Bronx. As primary-care providers in one of the poorest urban counties in the US, we see firsthand the impact that access to health care–and the lack thereof–can have on our patients. The narratives we share are the personal stories of people who’ve been able to receive health care through the Affordable Care Act (ACA) and combined Medicaid/Medicare coverage. Repealing the ACA will deal a serious blow to health justice. The US is the only developed nation that does not recognize health care as a fundamental human
Jo Marie Reilly
There’s a full moon tonight.
“That’s when crazy things happen,” my superstitious mom always says.
I’m a family physician doing weekend call at my urban community hospital. My pager rings incessantly. As I answer yet another call from the emergency room downstairs, I think, Maybe Mom has a point.
“Got a suicidal patient with nowhere to go,” the ER physician yells into the phone, against the background commotion. “This guy John has been here for three days. He’s casted on both feet and can’t walk. The insurance company’s authorization nurse says she can’t admit him because it’s not medically indicated–but if a doctor gives her an indication, she’ll authorize it. Can you do it?”
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